Different Endovascular Referral Patterns Are Being Learned in Medical and Surgical Residency Training Programs

Physicians in residency training will be the referring physicians of tomorrow. We sought to determine the current surgical and medical trainees’ perception of vascular surgery’s endovascular qualifications and capabilities. An anonymous survey was sent to all general surgery and internal medicine residents at a single academic institution. Respondents answered the question “Which specialty is the most qualified to perform (1) inferior vena cava (IVC) filter insertion; (2) angiograms, angioplasty, and stenting of the carotid arteries; (3) renal arteries; (4) aorta; and (5) lower extremity arteries?” For each question, respondents chose one response, either vascular surgery, interventional radiology, interventional cardiology, or do not know. One hundred respondents completed the survey (general surgery, n = 50; internal medicine, n = 50). There was a significant difference in the attitudes of surgery and medicine residents when choosing the most qualified endovascular specialist (p < 0.05). Surgery residents chose vascular surgery as the most qualified specialty for each listed procedure: carotid (80%, n = 40), IVC (56%, n = 28), aorta (100%, n = 50), extremity (86%, n = 43), renal (78%, n = 39). Medicine residents chose vascular surgery as the most qualified specialty less frequently: carotid (66%, n = 33), IVC (6%, n = 3), aorta (88%, n = 44), extremity (72%, n = 36), renal (16%, n = 8). There was no significant difference in specialty selection based on postgraduate year. There is a large discrepancy between surgical and medical trainees’ perception of vascular surgery’s endovascular abilities, particularly regarding IVC placement and renal artery interventions. If our own institution mirrors the nation, each passing year a significant portion of the 21,722 graduating internal medicine residents go into practice viewing vascular surgeons as second-tier endovascular providers. A concerted campaign should be undertaken to educate medical residents regarding the skills and capabilities of vascular surgeons.